Chronic Relapsing Pancreatic Disease Of The Tropic Or Pancreatic Diabetes As The Main Cause Of Mellituria
Mellituria Affects More of Childre
Chronic relapsing pancreatitis is confined almost exclusively to the tropics, mainly in Africa, India, Indonesia and Malaysia. In India for instance, most of the cases have been reported from the midland and the hilly tracts of the southern districts of Kerala and Tamil Nadu. Smaller numbers have been reported from many other parts, especially Karnataka and Orissa.
Etiology And Pathogenesis: Almost all cases belong to the poor socio-economic groups which consume cassava as their staple food, and in whom protein caloric malnutrition, helminothiasis, and frequent viral infections are common. The established causes of pancreatitis such as alcoholism, gall bladder disease, hyperparathyroidism and hyperlipidemias are absent in these cases. The disease may affecte several members in the same household.
Pathology: The pancreas shows intra and inter acinar fibrosis with moderate round cell infiltration. The acini and islets undergo total atrophy and replacement by fat. The ducts are dilated and numerous intraductal calculi made up of calcium in the itnerstices. The beta cells of the islets are reduced and this accounts for the diabetic state. The liver shows mainly glycogen infiltration and rarely fatty change and cirrhosis. In long-standing cases, the kidneys, retina and peripheral nerves show lesions similar to those seen in maturity- onset diabetes. The parotid glands are prominent and they show ductal dialatation and round cell infiltration.
Epigastric Pain Is A Major Sign
The disease affects children and young adults in the age groups of 15 to 35 years. Both sexes are equally affected. In one third cases, previous history of painful episodes of recurrent pancreatitis may be available. The pain is of a colicky or gnawing nature felt over the epigastrium. This differs from that of peptic ulcers in having no relation to food and not being relieved by antacids. Pressure over the episgatrium gives prompt relief. The physical appearance of these subjects is diagnostic. They show extreme emaciation, distention of the upper abdomen, cyanotic hue of the lips, and bilateral painless parotid enlargement. Growth and development are retarded. Women develop secondary amenorrhea. Urinary bladder is grossly distended and atonic. The patients generally seek treatment for diabetes or its complications.
The diabetic state is often severe, requiring high doses of soluble insulin for control. In the majority of cases, the fasting and postprandal blood glucose levels are high. With the passage of time, the diabetes becomes brittle in many cases.
Laboratory features: Fasting and postpandial blood glucose levels are very high. Pancreatic enzymes are lowered. Plasma immunoreactive insulin is reduced.